Healthcare Provider Details

I. General information

NPI: 1295923746
Provider Name (Legal Business Name): JESSICA MAE HUSTY PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. JESSICA MAE JONES

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW STE 1250
WASHINGTON DC
20036-1728
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 888-663-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9104337
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200002355
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: